Self-care in Emergency Medicine

I recently read this post on Tumblr and found it very insightful. The truth is I sometimes find myself too wrapped up in EMS and have a little trouble disconnecting. I know, it’s surprising to me as well. But I think we have all been there, we are in the middle of a nice day off and when someone asks a question about how work has been we launch into a 10 minute story. We go to the book store and somehow we find ourselves in the medical section instead of the new fiction. That is not always bad, but sometimes it does us good to find something different to occupy our minds with.

For me, my oxygen mask is sometimes music, sometimes it’s books, which sometimes aren’t even the good ones, just cheap little thrills to pass some time. Movies, my family, yeah they sometimes drive me nuts but still. Sometimes it’s a walk in the park with good music on my earphones….yeah I like that one, I think I will do this one right now.

Here’s the link and post:

Link: http://blaumau5.tumblr.com/post/61711146326/self-care-in-emergency-medicine-yes-it-is-ok-to-be

Self-care in Emergency Medicine: Yes, it is ok to be nice to yourself.

Self-care. It’s a biggie for those in professions that address the needs of others. Not that I’m going to write solely about 9/11 today, but I have to admit that this year’s anniversary really affected me differently. It prompted me to think long and hard about maintaining my emotional health while caring for others for a living.

Most of you readers are probably strangers. To give you some background information and context, I’m an EMT on a 911 ambulance in a rural area. Much of our service area is poverty stricken, and we see horrific traffic accidents on highways boasting speed limits of 75. One morning you may have to dig a hoarder in cardiac arrest out of their toxic wasteland of a home, and by nightfall you’re wrestling with a gaunt meth addict. Other times you just end up checking grandma’s blood pressure and leave with Snickerdoodle cookies.

I didn’t get into EMS until my late twenties, as I was finishing my undergraduate degree. With that said, I’ve approached my job from a different perspective than that of many in the profession. I didn’t get my certification as a naïve teenager, and I have a well-rounded liberal arts education in the social sciences to go with it. It has greatly benefited me and made me a more compassionate provider, but at the same time I think it makes some aspects of the job more emotionally taxing. I’m generally quite good at handling the stresses of the job, but sometimes I am disheartened by the awful things I see. Sometimes I feel overly sensitive to things that probably wouldn’t bother other people, and in contrast I’m unfazed by situations that would send most people into a panic. It’s a little like living in a parallel universe that the rest of the world sees but doesn’t fully understand.

When the anniversary of 9/11 arrived this year, I felt differently about taking time to remember it. During the 12 years that have spanned between then and now, I have generally just gone about my business and moved on. I was a teenager at the time it occurred, so I remember the attack very clearly. In 2006 I visited Ground Zero to pay my respects in person. I just felt like it was something I really needed to do. This year, I felt that revisiting the media coverage from that day was also something I just ‘needed to do.’ I saw it almost as a masochistic duty. I’m older, wiser, and now that I’ve been a first responder for a while I’ve seen a lot of horrific things firsthand. I wanted to know how I would react after gaining those experiences.

While at work that day I queued up as many 9/11 videos as possible on my iPhone. What I really didn’t expect was the overwhelming sense of dread and sadness that I felt while viewing them. It was almost like something was pulling me downward and draining any trace of well-being from my body. I felt tense and depressed and anxious. I felt like I had experienced the whole day all over again, and this time it seemed realer than real. The sounds of emergency vehicles in the videos, which I am now intimately familiar with, elicited a near panic response from me. I could picture myself there as if I had responded as an EMT, triaging patients and trying to make sense of the chaos, wondering how much worse the situation was going to get. It felt like I was helplessly watching something unfold that I desperately needed to respond to.

Eventually I just had enough of it. I was in such a heightened state of anxiety and alertness that I literally could not relax without filling my head with something mindless and unrelated. I had to turn off the documentaries and news clips in exchange for cartoons on Nickelodeon, which I generally don’t watch anymore.

The next day I thought about it and wondered why on earth I willingly made myself miserable. This isn’t something entirely out of the ordinary for me though: at times I feel obligated to experience negative emotions. Then I remembered something I had recently read in a book about the effects of trauma exposure on workers in fields such as mine: we tend to experience guilt about how good our lives are in comparison to our patients. People who routinely work with clients or patients that are in much greater distress than themselves often try to downplay the positive things in their lives, in an effort to not flaunt them around those in terrible situations. (Such as domestic violence victims, the homeless, the terminally ill, etc.) The happily married counselor may be reluctant to talk about his children around a battered woman in the shelter where he works, or a fit paramedic may not feel comfortable sharing information about her last hiking trip when treating a paraplegic.

I realized that this is exactly what I do from time to time. I feel so guilty that others have gone through something horrendous that I feel obligated to share their grief. I’m not entirely sure why sometimes, because my life is far from perfect. I have plenty of emotional scars from fighting my own battles. When faced with large scale disasters though, which I have only experienced peripherally, I tend to fall all over myself trying to help and empathize.

Sometimes I wonder where the dividing line is between being a compassionate, soulful human being and being slightly insane.

Either way, being mindful of this tendency is the best thing I can do as a first responder. It’s also a good idea for anyone who has witnessed traumatic events involving others, which is essentially everyone at some point in their life.

I do, however, feel fortunate that I still have this much compassion and empathy for others. It can be difficult to not hate everyone when you see people at their worst on the regular. I’ve been a public servant for almost 6 years, even though less than two of those have been in EMS. Some days I just don’t even want to have contact with human beings because I am so tired of their trivial crap. I just want to nap on the couch with my cats and eat dark chocolate.

I think the field has made me more self-aware though. I suppose you could say that’s the moral of this story. I’m more conscious of the fact that I absolutely must engage in self-care or I’ll burn out, and I really don’t want to ever burn out of emergency medicine. Part of that is in the interest of my own career, and part of that is for the sake of my patients. (So much for trying to have a mostly internal locus of control.) There are a lot of other providers whom I know experience the same things, but don’t talk about them necessarily.

So here’s to making sure the conversation of self-care continues.

During undergrad, my clinical psychology professor used a great analogy. You know how airline attendants always say, ‘In the event of a crash, put on your own oxygen mask before assisting others?’ It’s the same principle. If you help others first – and then pass out – you’re rendered useless. Then you can’t help anyone.

My metaphorical “oxygen mask” is playing in a rad brass band, gardening, reading, writing, taking photos on road trips, and making sure I surround myself with positive people. I don’t really watch much news outside of staying current on major international happenings, because let’s face it – I don’t need to hear about the 20th rape that’s been reported locally this year. I see assault victims in person enough.

Instead I read about people doing nice things on Buzzfeed and Upworthy, and I scour Youtube for the funniest sketch comedy I can find. I make fart jokes. I speak in funny voices to my friends, just for the sake of being ridiculous and quirky. I’m not afraid to spend a little more for a quality meal at a nicer restaurant, when I can afford it.

I laugh at myself.

I daydream.

What’s your oxygen mask?

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